Primary Urethral Cancer: A Retrospective Analysis of 27 Patients at a Single Institute

ABSTRACT Background There is a paucity of information in the literature on primary urethral cancer (PUC). We carried out a retrospective study regarding the treatment and outcome in patients (pts) with PUC. Methods Twenty-seven consecutive pts (3 males and 24 females) with a confirmed diagnosis of PUC undergoing initial treatment between 1997 and 2011 at Asan Medical Center in Korea were reviewed. Low stage was defined as T2N0M0 or less and high stage was defined as more advanced stages. Results The median age was 57 years (14–83). Thirteen pts had low stage and 14 pts high stage. In the low-stage group (n = 13), 10 pts underwent surgery and 3 pts received chemoradiotherapy. A surgical complete resection (R0) achieved in 90% (9/10) and one patient with microscopically positive resection (R1) was treated with post-operative radiotherapy. Two (15.4%) pts in the low-stage group developed recurrence with local failure. In the high-stage group (n = 14), 11 pts underwent radical resection, 2 pts received chemoradiotherapy and 1 patient with distant metastasis received chemoradiotherapy. R0 achieved in 45.5% (5/11) and 6 pts with R1 were treated with post-operative radiotherapy (n = 4), chemoradiotherapy (n = 1) or chemotherapy (n = 1). In the high-stage group, there was no difference in survival outcomes between R0 (n = 5) and R1 (n = 6), and seven pts with recurrence after surgery had six distant metastasis and one local failure. The remaining two pts treated with chemoradiotherapy in the hgh-stage group showed the event-free survival of 42 and 53 months, respectively. With a median follow-up of 40 months (1–158), low stage was associated better event-free survival and overall survival compared with high stage (log-rank test: P = 0.006 and P = 0.002, respectively). Conclusions High-stage PUC showed different clinical behaviors and managements compared with low stage. In this study, surgery is pivotal in PUC pts with low stage. The multidisciplinary approach may be required to obtain an optimum oncologic outcome in high-stage PUC.